[The effects of ethylbenzene on HEI-OC1 cells proliferation and oxidative stress level].

Objective: To study the changes of proliferation and oxidation indexes of Cochlear hair cell line (HEI-OC1 cells) exposed to ethylbenzene. Methods: From July to December 2019, 11 groups with ethylbenzene concentrations of 0, 30, 60, 90, 300, 600, 900 µmol/L and 3, 6, 9, 10 mmol/L, were used to determine the proliferation activity of HEI-OC1 cells exposed to ethylbenzene for 24 hours, and the cells were treated with 0, 1, 2, 4, 8, 16, 32, 64 mmol/L ethylbenzene for 24 hours, then the 50% inhibitory concentration of ethylbenzene was calculated. After HEI-OC1 cells were exposed to 0, 6, 9 and 12 mmol/L ethylbenzene for 24 hours, the malondialdehyde (MDA) content, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were measured. Results: Compared with 0 mmol/L concentration group, the survival rate of HEI-OC1 cells at 6, 9, 12 mmol/L concentration was significantly decreased (P<0.01) . The 50% inhibitory concentration of ethylbenzene on HEI-OC1 cells was 12.86 mmol/L (R(2)=99.05) . There were significant differences in SOD and GSH-Px activity in HEI-OC1 cells treated with ethylbenzene at different concentrations (0, 6, 9, 12 mmol/L) for 24 hours (F=65.11, 6.48, 22.85, P<0.05) . Compared with 0 mmol/L concentration group, the MDA content of HEI-OC1 cells was significantly increased in 9 and 12 mmol/L concentration groups, the SOD activity was significantly decreased in 12 mmol/L concentration group, and the GSH-Px activity was significantly decreased in 6 and 12 mmol/L concentration groups. Conclusion: Ethylbenzene can inhibit the proliferation of HEI-OC1 cells and cause oxidative damage.

[Effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia].

OBJECTIVE: To compare the effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia. METHODS: In the study, 40 patients with American Society of Anesthesiologists (ASA) physical statuses I-II, aged 19-66 years, scheduled for elective thoracic surgeries under general anesthesia requiring orotracheal intubation were allocated to either the double-lumen endobronchial intubation (T group) or double-lumen endobronchial intubation after epidural administration of lidocaine (E group). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy (MDLS), respectively. Invasive blood pressure (BP), heart rate (HR) and bispectral index (BIS) were recorded before and after anesthetic induction, immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time also noted. The rate pressure product (RPP) was calculated. RESULTS: After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. In comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BPs, HRs and RPP. In comparison with their preinduction values, BPs decreased significantly in E group, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1 min in T group. The HRs of both groups after intubation were significantly higher than their baseline values , and increased in HR and lasted for 1 min and 4 min in E group and T group, respectively. SBP, DBP, MAP, HR and RPP after intubation in T group were significantly higher than those of E group during the observation period. The values of BIS were similar between both the groups. In T group, the incidences of SBP percent increased>30% of the baseline value and RPP more than 22 000 were significantly higher than in E group. None of the patients in group E had SBP more than 130% of the baseline value and RPP more than 22 000. CONCLUSION: During double-lumen endobronchial intubation, epidural administration of lidocaine can provide less hemodynamic response and similar arousal response.

Downregulated miR-328 suppressed cell invasion and growth in hepatocellular carcinoma via targeting PTEN.

OBJECTIVE: To investigate the regulatory effect of miR-328 on biological behaviors of hepatocellular carcinoma (HCC) cells, such as invasion and proliferation. PATIENTS AND METHODS: The expressions of miR-328 were detected in 48 pairs of HCC tissue samples and matched adjacent tissues, as well as in 3 kinds of HCC cell lines via quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Further, we analyzed the effects of miR-328 inhibition on cell invasion, proliferation, cell apoptosis, and cell cycle. Dual-luciferase activity assay was performed to examine the potential target gene PTEN which was predicted by an online database. Protein levels were detected using Western blot assay. RESULTS: The expression of miR-328 was significantly increased in HCC tissue samples. Decreased miR-328 in HCC cells significantly attenuated cell invasion and proliferation capacities, promoted cell apoptosis and induced cell cycle arrest at G0/G1 phase. Moreover, PTEN was verified as a target gene of miR-328 by dual-luciferase activity assay, qRT-PCR and Western blot. Furthermore, the silence of PTEN neutralized the suppressive effect of decreased miR-328 on cell growth and metastasis. CONCLUSIONS: MiR-328 is involved in the development of HCC via regulating PTEN, which might provide a new target for HCC diagnosis and therapy.

[Clinical application of high frequency jet ventilation in cryotherapy for tracheo-bronchial carcinoma via rigid bronchoscopy].

Objective: To analyze the clinical applications of high frequency jet ventilation(HFJV) in cryotherapy of the trachea and bronchial neoplasms by the rigid bronchoscope. Methods: The clinical data of 35 patients who were treated with tracheal neoplasms cryotherapy by the rigid bronchoscopy under HFJV were collected in China-Japan Friendship Hospital from August 2008 to February 2015.Under general anesthesia, HFJV was used in all patients. The mean arterial pressure (MAP), heart rates (HR), pulse oxygen saturation (SpO(2)), results of arterial blood gas analysis and the incidence of complications during the procedure were recorded. Results: In the 35 patients, one case had multiple operations experience, he had an airway spasm after HFJV 40 min during his second operation, and severe hypoxemia after HFJV 5 min during his third operation, endotracheal intubation was performed immediately. The patient has a serious accumulation of carbon dioxide (CO(2)) whose partial pressure of carbon dioxide in the artery (PaCO(2)) was up to 71 mmHg(1 mmHg=0.133 kPa). Other patients had stable hemodynamics and no severe CO(2) accumulation. Conclusion: High frequency jet ventilation can provide satisfactory ventilation effect in cryotherapy of the trachea and bronchial end-stage neoplasms by the rigid bronchoscope.

Application of a triblock copolymer additive modified polyvinylidene fluoride membrane for effective oil/water separation.

A hollow fibre membrane was fabricated by blending polyvinylidene fluoride (PVDF) with a triblock copolymer additive polymer that has both hydrophilic and oleophobic surface properties. The novel membrane was characterized and examined for oil/water separation under various system conditions, including different cross-flow rate, feed temperature, trans-membrane pressure, and its rejection and cleaning efficiency, etc. By applying the membrane into the filtration of synthesized oil/water emulsion, the membrane constantly achieved an oil rejection rate of above 99%, with a relatively constant permeate flux varied in the range of 68.9-59.0 l m-2 h-1. More importantly, the fouling of the used membrane can be easily removed by simple water flushing. The membrane also demonstrated a wide adaptability for different types of real oily wastewater, even at very high feed oil concentration (approx. 115 000 mg l-1 in terms of chemical oxygen demand (COM)). Hence, the novel triblock copolymer additive-modified PVDF membrane can have a great prospect in the continuing effort to expand the engineering application of polymeric membranes for oily wastewater treatment.

Clinicopathologic risk factors for right paraesophageal lymph node metastasis in patients with papillary thyroid carcinoma.

OBJECTIVES: To investigate risk factors associated with right paraesophageal lymph node (RPELN) metastasis in patients with papillary thyroid carcinoma (PTC) and to determine the indications for right lymph node dissection. METHODS: Clinicopathologic data from 829 patients (104 men and 725 women) with PTC, operated on by the same thyroid surgery team at the First Affiliated Hospital of Harbin Medical University from January 2013 to May 2017, were analyzed. Overall, 309 patients underwent total thyroidectomy with bilateral lymph node dissection, 488 underwent right thyroid lobe and isthmic resection with right central compartment lymph node dissection, and 32 underwent near-total thyroidectomy (ipsilateral thyroid lobectomy with contralateral near-total lobectomy) with bilateral lymph node dissection. RESULTS: The overall rate of central compartment lymph node metastasis was 43.5% (361/829), with right central compartment lymph node and RPELN metastasis rates of 35.5% (294/829) and 19.1% (158/829), respectively. Tumor size, number, invasion, and location, lymph node metastasis, right central compartment lymph node metastasis, and right lateral compartment lymph node metastasis were associated with RPELN in the univariate analysis, whereas age and sex were not. Multivariate analysis identified tumors with a diameter ≥ 1 cm, multiple tumors, tumors located in the right lobe, right central compartment lymph node metastasis, and right lateral compartment lymph node metastasis as independent risk factors for RPELN metastasis. CONCLUSIONS: Lymph node dissection, including RPELN dissection, should be performed for patients with PTC with a tumor diameter ≥ 1 cm, multiple tumors, right-lobe tumors, right central compartment lymph node metastasis, or suspected lateral compartment lymph node metastasis.

Benign mixed tumor of the vagina.

Mixed tumor of the vagina is a rare benign tumor containing both epithelial and mesenchymal components. The authors report the case of a 35-year-old woman who presented with a painless mass that had descended from the vagina in the last six months. Physical examination showed the presence of a solitary, non-tender nodule that was 3x3x2 cm in size and seemed to originate from the posterior wall of the lower vagina. The tumor was removed and pathologically examined. The findings were indicative of a mixed tumor of the vagina, and were in agreement with previous cases. No recurrence or progression occurred during the ten-month follow-up. As this tumor shares common features with some other tumors, its differential diagnosis is very important. Moreover, due to the rarity of this disease, gynecologists and pathologists need to familiarize themselves with the features in order to avoid a misdiagnosis.

A randomized controlled trial of self-regulated modified constraint-induced movement therapy in sub-acute stroke patients.

BACKGROUND AND PURPOSE: Emerging research suggests the use of self-regulation (SR) for improving functional regain in patients post stroke. SR is proposed to produce an added effect to effective modified constraint-induced movement therapy (mCIMT). This study aimed to examine the effect of a self-regulated mCIMT programme (SR-mCIMT) for functional regain in patients with sub-acute stroke. METHODS: Eighty-six patients completed the trial: SR-mCIMT, n = 29; mCIMT, n = 31; or conventional functional rehabilitation, n = 26. All interventions were 2-week therapist-guided training. Outcome measurements, taken by a blinded assessor, examined arm function [Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA)], daily task performance [Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)] and self-perceived arm use in functional tasks [Motor Activity Log (MAL)]. RESULTS: Significant differences were found with the SR-mCIMT outperforming the other groups after the intervention (ARAT, P = 0.006; FMA, Lawton IADL and MAL, all Ps < 0.001). In terms of the carry-over effect, the SR-mCIMT group outperformed in the hand and coordination subscales of ARAT and FMA (P = 0.012-0.013) and the self-perceived quality of arm use (P = 0.002). CONCLUSION: A combination of SR and mCIMT could produce an added effect in functional regain in patients post stroke.

Age-related effects on perceptual and semantic encoding in memory.

This study examined the age-related subsequent memory effect (SME) in perceptual and semantic encoding using event-related potentials (ERPs). Seventeen younger adults and 17 older adults studied a series of Chinese characters either perceptually (by inspecting orthographic components) or semantically (by determining whether the depicted object makes sounds). The two tasks had similar levels of difficulty. The participants made studied or unstudied judgments during the recognition phase. Younger adults performed better in both conditions, with significant SMEs detected in the time windows of P2, N3, P550, and late positive component (LPC). In the older group, SMEs were observed in the P2 and N3 latencies in both conditions but were only detected in the P550 in the semantic condition. Between-group analyses showed larger frontal and central SMEs in the younger sample in the LPC latency regardless of encoding type. Aging effect appears to be stronger on influencing perceptual than semantic encoding processes. The effects seem to be associated with a decline in updating and maintaining representations during perceptual encoding. The age-related decline in the encoding function may be due in part to changes in frontal lobe function.

Different small-dose remifentanil blunting the cardiovascular response to laryngoscopy and intubation in children: a randomized double-blind comparison.

BACKGROUND: The available data provide inconsistent results on the efficacy of small-dose remifentanil attenuating the cardiovascular response to intubation in children. Therefore, this randomized double-blind study was designed to assess the ability of different small doses of remifentanil on the cardiovascular intubation response in children, with the aim of determining the optimal dose of remifentanil for this purpose. METHODS: One hundred and twenty-four children aged 3-9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), remifentanil 0.75 microg kg(-1) (Group 2), remifentanil 1 microg kg(-1) (Group 3) and remifentanil 1.25 microg kg(-1) (Group 4). Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and at 1 min intervals for 5 min after intubation. RESULTS: Tracheal intubation caused significant increases in systolic blood pressure and heart rate in Groups 1-3 compared with the baseline values. The maximum percent increases of systolic blood pressure and heart rate were 10% and 26% of the baseline values, respectively, in Group 2; 5% and 14% in Group 3; and 1% and 8% in Group 4 compared with 27% and 37% in Group 1. Except for the Group 3 vs. Group 4 comparison, there were significant differences among the four groups in the maximum percent increases of systolic blood pressure and heart rate. CONCLUSIONS: When used as part of anaesthesia induction with propofol and vecuronium in children, bolus administration of remifentanil resulted in a dose-related attenuation of the cardiovascular intubation response.

Use of the Interact Short Form as a tool to evaluate emotion of people with profound intellectual disabilities.

BACKGROUND: One of the essential purposes of intervention programmes for people with profound intellectual disabilities (ID) is to enhance the desirable mood and behaviour and decrease the undesirable ones through stabilizing their emotion. There is lack of validated instrument to offer a comprehensive measure that covers the mood and behaviour, both desirable and undesirable, appropriate for people with profound ID. METHOD: This study aimed to examine the validity and reliability of the Interact Short Form for evaluating the mood and behaviour of people with profound ID, and at the same time, review their emotional profile using the Interact Short Form. Both content validity using expert panel review and construct validity by means of factor analysis were investigated. A total of 75 people with profound ID were recruited. Inter-rater reliability was tested. The results of the Interact Short Form were described to reflect the emotional profile of this group of participants. RESULTS: Using the results of expert panel review and those from factor analysis, we found three subscales representing the mood and behaviour of people with profound ID. They were: 'emotional expression', 'interests towards tasks' and 'behaviours to environment'. All three subscales were found to be internally consistent (alpha = 0.71-0.88). The Interact Short Form- People with profound ID version also showed good inter-rater reliability (mean = 0.72). The results of the Interact Short Form showed that this group of participants had fairly stable emotion under the structured setting and activities in the residential institutions where data were collected. CONCLUSIONS: The Interact Short Form- People with profound ID version serves as a helpful tool for both clinical and research use in assessing the mood and behaviour of people with profound ID in a simple, comprehensive and systematic way.

Activities of daily living performance in dementia.

OBJECTIVE: To explore the activities of daily living ADL performance profile of community-living people with dementia and to investigate its relationship with dementia severity. MATERIALS & METHODS: ADL performance of 86 subjects were evaluated using Barthel Index (BI), Lawton and Brody's Instrumental Activities Daily Living (IADL) and Assessment of Motor and Process Skills (AMPS). Dementia severity was measured by Clinical Dementia Rating (CDR). RESULTS: Subjects were able to perform most basic ADL (BI mean = 16.4) and some IADL (Lawton and Brody's IADL mean = 4.3). The AMPS process ability measure and the Lawton and Brody's IADL were significantly correlated with CDR (P < 0.01). CONCLUSIONS: Subjects with mild dementia were able to perform mostly all basic ADL and some IADL. The AMPS process ability measure and the Lawton and Brody's IADL could provide useful information on their ability to live independently in the community.

The circulatory responses to tracheal intubation in children: a comparison of the oral and nasal routes.

The circulatory responses to laryngoscopic tracheal intubation in 62 healthy children undergoing surgery requiring tracheal intubation were studied. They were randomly assigned to receive either the oral or nasal route for intubation. Baseline non-invasive blood pressure and heart rate were recorded following induction of anaesthesia, at intubation and then every minute for 5 min. The percentage changes of systolic blood pressure and heart rate during the measurement period were calculated. The results demonstrated that intubation time was significantly longer in the nasal group. Both oral and nasal intubation caused significant increases in blood pressure and heart rate compared to baseline and postinduction values. However, there were no significant differences found between the two groups in relation to blood pressure and heart rate. The two groups were similar with respect to the percentage changes of systolic blood pressure and heart rate during the observation period. It is concluded that oral and nasal intubation using a direct laryngoscopy can result in a similar circulatory response in anaesthetised children.

Blood pressure and heart rate changes during fibreoptic orotracheal intubation: a comparison of children and adults.

BACKGROUND AND OBJECTIVES: Autonomic circulatory regulation and airway anatomy in children are significantly different from those in adults. There is no available published data to compare whether there is a clinically relevant difference in the haemodynamic responses to fibreoptic orotracheal intubation (FOI) under the same conditions between children and adults. In this randomized clinical study, we compared the blood pressure (BP) and heart rate (HR) changes during FOI in 40 children aged 3.5-9 yr and 40 adults aged 21-57 yr, ASA 1 scheduled for elective plastic surgery under general anaesthesia requiring orotracheal intubation. METHODS: Anaesthesia was induced with intravenous (i.v.) injection of fentanyl and propofol, and face mask inhalation of isoflurane before FOI. Noninvasive BP and HR were recorded before induction (baseline values), after induction (postinduction values), at intubation and for 5 min after intubation at 1-min intervals. The percentage changes of BP and HR at each time point were calculated. RESULTS: In children and adults, HR at intubation and 1-3 min after intubation were significantly higher than baseline and postinduction values. In adults, BP at intubation increased significantly compared to the postinduction values but did not exceed baseline values. In children, BP at intubation and 1 min after intubation were significantly higher than postinduction and baseline values. As compared to adults, FOI caused a more significant pressor response in children. The percentage changes of BP at intubation and 1 min after intubation were larger in children than in adults. However, there was no significant difference in the percentage change of HR during the observation between children and adults. CONCLUSIONS: Under general anaesthesia, FOI might cause a more significant pressor response in children than in adults.

A comparative study of hemodynamic responses to orotracheal intubation with fiberoptic bronchoscope and laryngoscope in children.

BACKGROUND: The purposes of this study were to further identify the hemodynamic responses to orotracheal intubation in children, using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS), and to validate whether the FOB can attenuate the hemodynamic response to orotracheal intubation compared with the DLS. METHODS: Forty-three children, ASA PS I-II scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were randomly allocated to either the DLS group (n = 20) or the FOB group (n = 23). Noninvasive systolic blood pressure (SBP) and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation and every minute for the first 5 min after intubation. The maximal values of SBP and HR during the observation were also recorded. The product of HR and SBP [rate pressure product (RPP)] at each time point was calculated. RESULTS: In the DLS group, SBP, HR, and RPP at intubation and 1 min after intubation were significantly higher than postinduction values, but did not exceed baseline values. In the FOB group, SBP, HR, and RPP at intubation increased significantly compared with baseline and postinduction values. In the two groups, the maximal values of SBP, HR, and RPP during the observation were significantly higher than baseline values. Except for the HR at intubation, there were no significant differences in other hemodynamic parameters during the observation and the time required to reach maximal values of SBP, HR, and RPP between the two groups. CONCLUSIONS: Orotracheal intubation using FOB and DLS in children may cause similar increases in SBP and HR. Compared with the DLS, the FOB had no advantage in attenuating the hemodynamic responses to orotracheal intubation.

The circulatory responses to fibreoptic intubation: a comparison of oral and nasal routes.

The circulatory responses to fibreoptic intubation under general anaesthesia were studied in 60 adult female patients who were randomly assigned to receive either the oral or nasal route for insertion. Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline values), immediately after anaesthesia induction (post-induction values), at intubation and every minute for a further 5 min. The product of heart rate and systolic blood pressure (rate pressure product) at every time point was also calculated. The results showed that both fibreoptic orotracheal intubation and fibreoptic nasotracheal intubation resulted in significant increases in blood pressure, heart rate and rate pressure product compared to baseline and post-induction values. The times required to reach the maximum values of systolic blood pressure and heart rate were significantly longer in the fibreoptic nasotracheal intubation group than in the fibreoptic orotracheal intubation group. There were no significant differences between the two groups in blood pressure, heart rate and rate pressure product at any measuring point, or in the maximum values during observation. The time required for recovery of systolic blood pressure to the post-induction value was not significantly different between the two groups, but the time required for recovery of heart rate to post-induction value was significantly longer in the fibreoptic orotracheal intubation group than in the fibreoptic nasotracheal intubation group. It was concluded that both fibreoptic orotracheal and fibreoptic nasotracheal intubations could cause a similar magnitude of circulatory responses in general anaesthetised, female adults, but the tachycardic response to fibreoptic orotracheal intubation lasted longer than that to fibreoptic nasotracheal intubation.

Blood pressure and heart rate changes during intubation: a comparison of direct laryngoscopy and a fibreoptic method.

Blood pressure and heart rate changes during nasotracheal intubation under general anaesthesia were studied in 100 patients who were randomly allocated to fibreoptic bronchoscope or direct laryngoscopy intubation. Noninvasive blood pressure and heart rate were recorded before and immediately after anaesthesia induction, at anaesthesia intubation and every minute thereafter for 5 min. Nasotracheal intubation was accompanied by significant increases in blood pressure and heart rate compared to baseline values in both groups. Blood pressure and heart rate at intubation, and the maximum values of blood pressure during the observation were significantly higher in the fibreoptic bronchoscope group. However, the maximum values of heart rate were not significantly different between the two groups. Fibreoptic nasotracheal intubation may result in more severe pressor and tachycardiac responses than direct laryngoscopic nasotracheal intubation.

The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate.

BACKGROUND: The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities. METHODS: A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1-6 months group, 6-12 months group and 1-3 years group. RESULTS: The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1-6 months group, 2.90% in 6-12 months group, and 3.13% in 1-3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively. CONCLUSIONS: Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.

Clinical protocols for hearing instrument fitting in the Desired Sensation Level method.

A discussion of the protocols used particularly in the clinical application of the Desired Sensation Level (DSL) Method is presented in this chapter. In the first section, the measurement and application of acoustic transforms is described in terms of their importance in the assessment phase of the amplification fitting process. Specifically, the implications of individual ear canal acoustics and their impact on accurately defining hearing thresholds are discussed. Detailed information about the statistical strength of the real-ear-to-coupler difference (RECD) measurement and how to obtain the measure in young infants is also provided. In addition, the findings of a study that examined the relationship between behavioral and electrophysiologic thresholds in real-ear SPL is described. The second section presents information related to the electroacoustic verification of hearing instruments. The RECD is discussed in relation to its application in simulated measurements of real-ear hearing instrument performance. In particular, the effects of the transducer and coupling method during the RECD measurement are described in terms of their impact on verification measures. The topics of insertion gain, test signals, and venting are also considered. The third section presents three summary tables that outline the hearing instrument fitting process for infants, children, and adults. Overall, this chapter provides both clinical and scientific information about procedures used in the assessment and verification stages of the DSL Method.